Puberty Females Referral Access Criteria
Puberty Females Referral Access Criteria
| Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for puberty (females). This RAC is applicable to referrals for patients aged <16 years only. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
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- Vaginal bleeding aged <8 years
- Sudden changes in pubertal development with or without neurological symptoms (e.g. headache, blurred vision)
To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
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| Clinical indications for outpatient referral |
| If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS). |
- Early onset (aged <2 years)
- Lack of pubertal signs (aged >13 years)
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| Mandatory information |
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Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration and severity of symptoms
- Current medication list including any relevant medication use that may influence pubertal development
- Any known allergies
- Familial history of height, weight and onset of puberty
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| Examination |
- Indicate presence or absence of café au lait spots >1.5cm
- Serial measurements of height and weight (ideally 6-12 months) in a growth chart
- Tanner stage: for breast development
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| Investigations |
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| Minimum WA public outpatient referral requirements |
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
- X-ray left hand for bone age
- Oestradiol level
- DHEA
- TSH, free T4
- LH, FSH
- Karyotype (in delayed puberty)
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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Signs of puberty in those aged <2 years
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Category 2
Appointment within 90 days
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Precocious puberty
- Girls <8 years with breast development with or without the signs as below:
- Progressing over time
- Accelerated growth
- Presence of multiple of café au lait spots >1.5cm (possible McCune Albright Syndrome)
Delayed puberty
- No breast development by 13 years of age or no menses by 15 years of age (note: consider Turner Syndrome in girls)
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Exclusions |
- Presence of fine downy and non-pigmented short hair in the supra pubic area (not considered secondary sexual pubic hair)
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Last reviewed: 18-03-2024